Program in Trauma, University of Maryland School of Medicine, Baltimore, USA.
Departments of Neurology, University of Maryland School of Medicine, Baltimore, USA.
Neurocrit Care. 2024 Dec;41(3):840-846. doi: 10.1007/s12028-024-02000-7. Epub 2024 May 21.
Smartphone use in medicine is nearly universal despite a dearth of research assessing utility in clinical performance. We sought to identify and define smartphone use during simulated neuroemergencies.
In this retrospective review of a prospective observational single-center simulation-based study, participants ranging from subinterns to attending physicians and stratified by training level (novice, intermediate, and advanced) managed a variety of neurological emergencies. The primary outcome was frequency and purpose of smartphone use. Secondary outcomes included success rate of smartphone use and performance (measured by completion of critical tasks) of participants who used smartphones versus those who did not. In subgroup analyses we compared outcomes across participants by level of training using t-tests and χ statistics.
One hundred and three participants completed 245 simulation scenarios. Smartphones were used in 109 (45%) simulations. Of participants using smartphones, 102 participants looked up medication doses, 52 participants looked up management guidelines, 11 participants looked up hospital protocols, and 13 participants used smartphones for assistance with an examination scale. Participants found the correct answer 73% of the time using smartphones. There was an association between participant level and smartphone use with intermediate participants being more likely to use their smartphones than novice or advanced participants, 53% versus 29% and 26%, respectively (p < 0.05). Of the intermediate participants, those who used smartphones did not perform better during the simulation scenario than participants who did not use smartphones (smartphone users' mean score [standard deviation] = 12.3 [2.9] vs. nonsmartphone users' mean score [standard deviation] = 12.9 (2.7), p = 0.85).
Participants commonly used smartphones in simulated neuroemergencies but use didn't confer improved clinical performance. Less experienced participants were the most likely to use smartphones and less likely to arrive at correct conclusions, and thus are the most likely to benefit from an evidence-based smartphone application for neuroemergencies.
尽管缺乏评估临床绩效效用的研究，但智能手机在医学中的应用几乎无处不在。我们试图确定并定义在模拟神经急症期间使用智能手机。
在这项回顾性前瞻性观察性单中心模拟研究中，参与者从住院医师到主治医生不等，并按培训水平（新手、中级和高级）进行分层，管理各种神经急症。主要结果是智能手机使用的频率和目的。次要结果包括使用智能手机的参与者和未使用智能手机的参与者的成功率和表现（通过完成关键任务来衡量）。在亚组分析中，我们使用 t 检验和 χ 统计比较了不同培训水平的参与者之间的结果。
103 名参与者完成了 245 个模拟场景。在 109 次模拟中使用了智能手机。在使用智能手机的参与者中，有 102 名参与者查找了药物剂量，52 名参与者查找了管理指南，11 名参与者查找了医院协议，13 名参与者使用智能手机协助检查量表。参与者使用智能手机的正确答案的比例为 73%。参与者的水平与智能手机的使用之间存在关联，中级参与者比新手或高级参与者更有可能使用他们的智能手机，分别为 53%、29%和 26%（p < 0.05）。在中级参与者中，使用智能手机的参与者在模拟场景中的表现并不优于未使用智能手机的参与者（使用智能手机的参与者的平均得分[标准差]为 12.3[2.9]，未使用智能手机的参与者的平均得分[标准差]为 12.9[2.7]，p = 0.85）。
参与者在模拟神经急症中经常使用智能手机，但使用并未带来临床性能的提高。经验较少的参与者最有可能使用智能手机，也最不可能得出正确的结论，因此最有可能从基于证据的神经急症智能手机应用中受益。
